بررسی پاسخ به درمان اسپلنکتومی در بیماران مبتلا به پورپورای ترومبوسیتوپنیک مزمن ایدیوپاتیک در بخش خون بیماستان حضرت علی‌اصغر(ع) طی سالهای 1378-1357

  ITP is an autoimmune disorder, due to increased platelet destruction. This condition may be acute, chronic or recurrent. In the acute form, the platelet count returns to normal within 6 months after diagnosis. In the chronic form, the platelet count remains low beyond 6 months.   In approximately 90% of children ITP is acute and self-limited disease. Splenectomy is indicated for severe acute ITP with life threateninig bleeding, which is nonresponsive to medical treatment. Splenectomy is also indicated for chronic form with bleeding symptoms or platelet count persistant below 30,000/mm3, which is nonresponsive to medical treatment for several years. The platelet count usually rises immediately after splenectomy, reaching a maximum 1 to 2 weeks postsplenectomy. If the peak of platelet count achived after splenectomy is above 500,000/ mm3, permanent remission is likely. In our study we evaluated 21 patients with chronic ITP that were splenectomized. In 18 patients, the duration of postoperation time was over 1 year and in 3 patients it was less than 2 months, so these 3 were not included in our final analysis.   We divided the patients in two groups:   1- Group(P): Patients responded to splenectomy (10 patients) In this group, resing of platelet count after   splenectomy in 6 patients was greater than 500,000/ mm3 and persistant at least for 1 year, without any medical therapy > 150,000/ mm3.   2- Group (N): Patients who did not respond to splenectomy (8 patients). We tried to find correlation between variables, and respond to splenectomy but because of limited number of patients, we achieved only a significant correlation between postsplenectomy response and patients age. Patients who had diagnosis of ITP in younger age, had better response to splenectomy later.   A correlation between response to IVIg therapy before splenectomy and postsplenectomy was also observed. Because half of the patients of P group had platelet count greater than 500,000/ mm3 with IVIg tharapyso it is concluded that patients who respond well to IVIg therapy in the primary treatment may show a better respond to splenectomy.